Adult Attention Deficit Disorder: Diagnosis, Coping and Mastery
In the past, Attention Deficit Disorder was believed to be a condition that affected children and some adolescents. Although it was known that children with AD/HD were more likely to have difficulties in adulthood, clinicians usually diagnosed and treated these as other conditions. During the past two decades, we have recognized attention deficit disorder in older adolescents and adults.
The diagnosis of Attention Deficit Disorder in adults can be a complex process. By definition, AD/HD is a condition that has its onset in childhood. Not everyone has an accurate recall of his or her early life. Often it is useful to get information from relatives, spouse or old school records.
As the child moves from adolescence to adulthood, the predominant symptoms of AD/HD tend to shift from external, visible ones (such as physical hyperactivity) to internal symptoms. There seems to be a decrease in observable symptoms of AD/HD with age. Although a given adult may not meet the full DSM-IV criteria for full AD/HD any longer, he or she may still experience significant impairment in certain aspects of life. Depending of professional or domestic situation, the adult may need to deal with more complex, abstract issues. A given individual’s perception of his or her degree of impairment may vary.
Many adults were never correctly diagnosed, even when they were children. Sometimes this was because their main symptoms were inattention and impulsivity rather than physical hyperactivity. In other cases, the individual used his or her high intelligence or great determination to mask the AD/HD symptoms. Often this compensation occurred at great emotional cost Many high-functioning individuals with AD/HD may harbor feelings of poor self-worth. They may see themselves as failures and feel that they constantly let others down. Over the years, the individual adapts to the situation. These adaptations, positive or negative, become part of one’s personality, layered over the AD/HD symptoms.
Adults with AD/HD are often bored with tedious, repetitive tasks. They may also trouble with planning and organization. Procrastination is common. Impulsivity may lead to frequent job changes, troubled romantic relationships, financial problems and a tendency to interrupt others. College students may have trouble staying focused on paperwork or lectures. The AD/HD adult often becomes frustrated or angry rapidly, but may cool off equally quickly. He or she is then left wondering why everyone else is still upset at the blow up. Because of difficulties following through on commitments, the individual is often called selfish and immature.
There is no magic cure for AD/HD, but many adults learn to manage it successfully. Treatment is often multi-modal. The most important starting point is an accurate diagnosis of the AD/HD and any associated medical and psychiatric conditions. Following the diagnosis, the individual should educate himself about the condition. Self-knowledge is necessary in order to learn coping and develop mastery. Adults often respond to the same medications used to treat AD/HD children. However, one may need to consider the adult’s size, and associated medical conditions and his or her other medications. New medications are expanding our ability to treat AD/HD with fewer side effects.
Treatment often involves teaching the adult to structure his or her life, while allowing for some spontaneity. Time management and planning are important skills. Daily planners and task lists are beneficial. Often the individual can enlist the help of family or coworkers to help him stay organized. It is important that the adult with AD/HD chose a vocation that suits his or her interests and personality style. It is often best to avoid jobs that emphasize weaknesses such as repetitive tasks, and find jobs that focus on one’s energy, and ability to shift from task to task. Individuals who experience physical restlessness should try to schedule regular exercise or work breaks. College students who need accommodations need to inform their school early, before problems arise. Examples of accommodations include untimed tests, the use of tape recorders in lectures or the right to take attests in a less distracting setting. Schools often require psychological testing to support special accommodations.
There has been increasing awareness that adults and children with AD/HD are at increased risk for other psychiatric disorders. Adults have lived longer than children, and thus have had more time to develop other associated psychiatric disorders. Often one must treat the other conditions before treating the AD/HD.
While AD/HD can be a burden for some, it can also be a gift. If it were an entirely negative trait, it would have died out thousands of years ago. Individuals with AD/HD are often energetic, creative and willing to take risks. Often this gift comes into focus after the individual acquires a degree of self-knowledge and learns to channel his energy and creativity.